Combining ADHD Medications
December 8, 2024
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Dr John Kruse Episodes Around December 8, 2024
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23:52Now PlayingCombining ADHD Medications
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The medications that the FDA has sanctioned for treating ADHD have all been approved as stand-alone agents only. But we know that combination medication therapy is widespread in the treatment of ADHD. Aren't stimulants powerful and dangerous enough alone? Why add on something else?
Despite the powerful ability of stimulants to reduce ADHD symptoms, for many, residual symptoms persist. Others can't tolerate stimulates, or have side effects (like insomnia) worsened by the drugs. Co-morbid conditions like depression, PTSD, anxiety, and OCD are common with ADHD, which also often prompts the use of combination therapy.
Most of the research on combination therapy for ADHD is descriptive - how often does it occur, with which medications, and for what subpopulations. But some experimental research indicates that two combinations: atomoxetine + stimulants and guanfacine + stimulants can lead to improved outcomes and does not increase the risk of serious side effects.
When combining medications, one should have clear treatment goals in mind, monitor responses closely, and start low, particularly with agents that may have overlapping modes of action.
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References:
Combined Stimulant and Guanfacine Administration in Attention-Deficit/Hyperactivity Disorder: A Controlled, Comparative Study (2016)
)302192/fulltext
A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, Including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability (2013)
A retrospective claims analysis of combination therapy in the treatment of adult attention-deficit/hyperactivity disorder (ADHD) (2009)
Combination pharmacotherapy for adult ADHD (2006)
Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy (2016)
Full Chapter list:
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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions.
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